Clavicle Fractures - clavicle articulates with sternum proximally and acromion distally - protects adjacent lung, brachial plexus, subclavian and brachial blood vessels - mid-portion of clavicle is thinnest and does not contain ligamentous or muscular attachments - signs/symptoms: swelling, deformity, tenderness overlying clavicle; arm is slumped inward and downward; limited ROM at shoulder - diagnosis: usually standard shoulder and clavicle X-rays, but may require 45-degree cephalad tilt view or CT - management: emergent orthopedic consult for open fractures, fractures with neurovascular injuries, fractures with persistent skin tenting
Middle Third Clavicle Fractures - most common - usually managed nonoperatively - risk factors for nonunion: initial shortening > 2 cm, comminuted fracture, displaced fracture > 100%, significant trauma, female, elderly - management: immobilization with either sling or figure-of-eight brace for 4 - 8 weeks - orthopedic follow up in 2 - 3 days: high risk of malunion, severely comminuted or displaced fractures, athletes, professional impact, cosmetic concerns - orthopedic follow up in 1 - 2 weeks for conservative treatment
Distal Clavicle Fractures - type I: fracture is distal to coracoclavicular ligaments with ligaments intact - type II: fracture is distal to coracoclavicular ligaments with disruption of ligaments -> causes upward displacement of proximal aspect of clavicle - type III: intra-articular fractures through acromioclavicular joint - management: types I and III can be managed conservatively with sling immobilization and follow up in 1 - 2 weeks; type II may require operative intervention
Proximal Third Clavicle Fractures - associated with high-mechanism injuries and associated with intrathoracic trauma - diagnosis: CT (also to identify additional injuries) - management: emergent consultation for posteriorly displaced fractures that compromise mediastinal structures; immobilization for all other proximal third fractures - orthopedic follow up in 1 - 2 weeks for conservative treatment
Resources Tintinalli's Emergency Medicine, 8th Edition